Neonatal Abstinence Syndrome Means Babies Are Born in Withdrawal

Babies who are exposed to drugs in the womb may be born with neonatal abstinence syndrome (NAS). Some people mistakenly believe these infants are born addicted to opioids. In fact, babies with NAS are born in withdrawal from opioids. They are not addicted to them.

If a mother is using opioids during her pregnancy, then she passes the drugs to her unborn baby from the bloodstream through the placenta, just as she provides food and oxygen. The baby can become physically dependent on the drugs during the pregnancy. Once born, the infant can experience withdrawal symptoms due to a significant decrease in the amount of drug activating the opioid receptors because the supply from the mother is no longer available. Symptoms may include seizures, twitching, poor sucking, slow weight gain, and breathing problems — for up to six months.

Treating Infants with Severe NAS Symptoms

According to Stanford Children’s Health, it can be difficult to keep babies with NAS comfortable. In cases where infants experience extreme withdrawal symptoms, they might need to receive an opioid similar to what the mother used during pregnancy.

The most common treatment approach is to provide the infant with an alternative supply of an opioid and then slowly taper to allow the body time to adjust to new, but lower, levels of opioids. This process takes time. But, if done properly, it can be accomplished without an infant experiencing the consequences of withdrawal.

The primary medication used will probably be methadone or morphine. The objective is to safely wean the baby off opioids.

Some of the symptoms can be managed with phenobarbital or other similar types of drugs that sedate the central nervous system. Phenobarbital doesn’t activate receptors the way that methadone does. It depresses the excitation generated by a lack of opioid receptor stimulation.

Dr. Jonathan Davis Seeks Uniform Treatment for Babies Born with NAS

Time magazine reports on a study that was recently published in JAMA Pediatrics. Dr. Jonathan Davis, vice chair of pediatrics at Tufts Medical Center, conducted research to find a “uniform strategy” for treating babies born with NAS.

Currently, Dr. Davis reports, “80% of NAS cases are treated with morphine, and 20% with methadone.” However, according to his findings, babies who received methadone had better outcomes. The babies who were treated with methadone needed far fewer doses of the drug during their hospital stay. Additionally, they were able to leave the hospital three days earlier, and they could stop receiving medication two days sooner.

Methadone is effective because it is a long-acting opioid. It can reduce withdrawal symptoms and drug cravings with less dosing intervals than with morphine.

Buprenorphine also is used in adults to reduce drug cravings and mitigate withdrawal symptoms, but it has seldom been used for newborns. However, there may be some benefits to using buprenorphine to treat NAS. One advantage is that buprenorphine is less likely to cause respiratory depression, so it may be safer than methadone or morphine.

Urgent Need for Approved Treatment of NAS

Treating withdrawal in infants appears to be similar to treating it in adults, but there may also be some important differences due to a baby’s immature nervous and respiratory systems. The immature nervous and respiratory systems make neonates more sensitive to many medications, including those used to treat NAS.

Currently, there is no drug approved for the treatment of NAS. Withdrawal is a horrible experience for adults and babies. Because of the increasing prevalence of NAS, there is a need for a uniform approach to treating the disorder. There is an urgent need for an approved medication to treat withdrawal in infants. That may be the next chapter of the national opioid crisis.